Tuesday, May 07, 2013

The Demise of the NHS

“The National Health Service is the envy of the world.” Enoch Powell


One of its basic principles of capitalist philosophy is that people should be made to pay, as far as possible for everything they receive, whether they be luxury goods or the necessities of life; they should never (except, conveniently, through inheritance and investments) get something for nothing. Those unable to pay their way should be pitied, charitably helped – but at the bare minimum in case they grow lazy and idle.

The National Health Service inherited all of the ills of the old private medical practice system. The general health of the vast majority of the population was bad. Employed workers had been covered by National Insurance since 1912, but not their wives, children and other dependents. A sick insured worker had the care of a doctor and free medicine, but none of the other specialised services were provided such as hospital stays or surgery nor the extras like X-rays, etc.

In 1942, Sir William Beveridge a Liberal member of Parliament, proposed a comprehensive health service which would “ensure that for every citizen there is available whatever medical treatment he requires in whatever form he requires it, domiciliary or institutional, general, specialist or consultant, and will ensure also the provision of dental, ophthalmic and surgical appliances, nursing and midwifery, and rehabilitation after accidents.” On July 5, 1948, the National Health Service began its operation.

Health standards have risen greatly, with contagious and nutritional deficiency diseases rates reduced. Infant mortality and childbearing deaths of mothers is low. The treatment of mentally ill persons has undergone a transformation as has the care of the aged. People who never dreamed of going to the doctor with minor ailments – which too often prove to be the symptoms of something major – now see the doctor in time.

The NHS treats people according to their health, not according to their wealth. The success and popularity of the NHS is because it is not subject to the market. The priorities of the NHS have no bearing on what patients can pay – only to what they need. When the NHS was set up, and when all medical services, even false teeth and spectacles, were free for everyone who needed them. The criteria was need, not the ability to pay. The NHS is very far from perfect, but it works far better than in the US, where almost all health care is bought and sold in the market place. It is also more efficient. There is a system of priority on the basis of need. A person who needs more gets priority over another who needs less. It also helped employers, who have known for a long time that personnel who are healthy are also more productive. Sure there were some problems. More preventive medicine should be expanded and doctors allowed more time per patient but these are not unsurmountable.

But health-care must be rationed the business leaders claim, and the obvious way to ration health is to subject it to the money market and make people pay more for what they want. Capitalism rations by the pocket although drugs are one of the largest expense item in the health budget and results in the pharmaceutical industry profitting greatly from NHS.

The National Health Service is so popular and works sufficiently well that outright privatisation is not a political option. The NHS has become so much a part of British life, that it would not be possible for anyone to avocate abolishing it now. People would not tolerate its removal and most members of the medical profession would now support them. Even the most right-wing free-marketeer recognise that to attempt to abolish the NHS would create a situation with which they would be unable to deal. Therefore, more insidious and effective is the propaganda which pretends to favour the principles of the NHS and then gradually erodes those principles, slow chipping away at the redistributive aspects of the NHS and the welfare services generally.

With the continuing capitalist crisis of capitalism and the onslaught of the present ConDem austerity policies, the welfare state is an expendable luxury. The health of the working class is irrelevant to capitalism in recession. Labour Party voters once believed it offered a welfare state that protected everybody from the cradle to the grave. That now has become a mirage.

David Kirkwood, a Red Clydesider who was elected to Parliament, in his autobiography wrote: “We were going to do big things. The people believed that. We believed that. At our onslaught, the grinding poverty which existed in the midst of plenty was to be wiped out. We were going to scare away the grim spectre of unemployment which stands grinning behind the chair of every artisan. We believed it could be done ... Alas, that we were able to do so little!”

Every new generation of reformist learns the same lesson. The view that a new society can be achieved in this way by legislating palliatives is spreading illusions that divert energy away from the vital struggle for socialism.

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